Dr Foster runs POA campaign

Dr Foster Intelligence is to launch a campaign for ‘present on admission’ flags to give a clearer picture of the care patients receive before and after hospital admission.

The campaign will be launched officially on 28 November, with the latest Hospital Guide.

It would lead to hospitals using a new clinical code to signify when a condition or diagnosis such as a pressure sore, deep vein thrombosis or heart disease, was present on admission.

The data would form part of the national dataset and be uploaded to the Secondary Uses Service.

The campaign already has the backing of the Royal College of Nursing, the Care Quality Commission, the Professional Association of Clinical Coders and seven NHS trusts.

Dr Foster Intelligence wants to see pressure sores as the first mandated POA flag, but other measures could follow quickly.

Andrew Kliman, senior communications manager at Dr Foster Intelligence, said: “POA flags for certain mandated conditions or diagnoses would give us a clearer picture of what is happening in people’s homes and in nursing homes at a time when more care is moving out of the hospital.

“It would also give us a clearer picture of where patients are being harmed within hospitals.”

POA flags are already used routinely in Australia and Canada and by Medicare and Medicaid services in the USA, he added.

And coding already exists to record when a condition is hospital acquired – Code Y95. This could be modified to create a new code to denote that the condition was present before admission.

Kliman argued that this new data item would not conflict with ministerial statements about the need to reduce the burden of data collection in the NHS.

He said: “The appetite is not for collecting data but for hospitals to have a clearer picture of what is happening within their care.”

Sue Eve-Jones, director of the Professional Association of Clinical Coders, said POA flags would help coders analyse data for clinicians and support new indicators measuring quality and outcomes.

She said: “There is a lot of work going on looking not just at what we did but whether it did any good. It is very difficult to do that if you do not know what happened when.”

POA flags would provide useful data without introducing the complications of coding for dates, she added.

The NHS Information Centre is already considering POA flags. The idea was raised as one of seven “key issues for discussion” in a May 2011 report on improving data quality and value, which was published jointly with the Academy of Medical Royal Colleges.

This proposed “a diagnosis present on admission flag to differentiate between events such as a broken leg, a pressure sore and acquisition of MRSA occurring prior to or during a hospital stay.”

The NHS IC is now considering responses from 1,083 clinicians who took part in a survey linked to the discussion document.

Dr Foster Intelligence will be raising the campaign with health minister Simon Burns.

Campaign supporters:

Mark Magrath, head of quality, Basildon and Thurrock University Hospitals NHS Foundation Trust

David Wise, medical director, Calderdale and Huddersfield NHS Foundation Trust

Julie Pearce, chief operating officer, East Kent Hospitals University NHS Foundation Trust

Catharina Schram, medical director, East Lancashire Hospitals NHS Trust

Anna Dugdale, chief executive, Norfolk and Norwich University Hospital

Andrew Foster, chief executive, Wrightington, Wigan and Leigh NHS Foundation Trust

Dr Ann Keogh, director of medical safety, Heart of England NHS Foundation Trust.